Superficial temporal artery access for carotid artery stenting: A case report

Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66-year-old man who presented with critical right internal carotid artery (ICA) stenosis after previous hospitalization due to stroke. In addition to arteria lusoria, the patient had known bilateral femoral amputation, occlusion of the left ICA and significant three-vessel coronary artery disease. After unsuccessful common carotid artery (CCA) cannulation from the right distal radial artery access, we successfully performed the diagnostic angiography and the planned right ICA-CCA intervention using superficial temporal artery (STA) puncture. We showed that STA access can be used as an alternative and additional access site for diagnostic carotid artery angiography and intervention when standard access sites alone are insufficient

Roles Played by the Na+/Ca2+ Exchanger and Hypothermia in the Prevention of Ischemia-Induced Carrier-Mediated Efflux of Catecholamines into the Extracellular Space: Implications for Stroke Therapy

The release of [3H]dopamine ([3H]DA) and [3H]noradrenaline ([3H]NA) in acutely perfused rat striatal and cortical slice preparations was measured at 37 °C and 17 °C under ischemic conditions. The ischemia was simulated by the removal of oxygen and glucose from the Krebs solution. At 37 °C, resting release rates in response to ischemia were increased; in contrast, at 17 °C, resting release rates were significantly reduced, or resting release was completely prevented. The removal of extracellular Ca2+ further increased the release rates of [3H]DA and [3H]NA induced by ischemic conditions. This finding indicated that the Na+/Ca2+ exchanger (NCX), working in reverse in the absence of extracellular Ca2+, fails to trigger the influx of Ca2+ in exchange for Na+ and fails to counteract ischemia by further increasing the intracellular Na+ concentration ([Na+]i). KB-R7943, an inhibitor of NCX, significantly reduced the cytoplasmic resting release rate of catecholamines under ischemic conditions and under conditions where Ca2+ was removed. Hypothermia inhibited the excessive release of [3H]DA in response to ischemia, even in the absence of Ca2+. These findings further indicate that the NCX plays an important role in maintaining a high [Na+]i, a condition that may lead to the reversal of monoamine transporter functions; this effect consequently leads to the excessive cytoplasmic tonic release of monoamines and the reversal of the NCX. Using HPLC combined with scintillation spectrometry, hypothermia, which enhances the stimulation-evoked release of DA, was found to inhibit the efflux of toxic DA metabolites, such as 3,4-dihydroxyphenylacetaldehyde (DOPAL). In slices prepared from human cortical brain tissue removed during elective neurosurgery, the uptake and release values for [3H]NA did not differ from those measured at 37 °C in slices that were previously maintained under hypoxic conditions at 8 °C for 20 h. This result indicates that hypothermia preserves the functions of the transport and release mechanisms, even under hypoxic conditions. Oxidative stress (H2O2), a mediator of ischemic brain injury enhanced the striatal resting release of [3H]DA and its toxic metabolites (DOPAL, quinone). The study supports our earlier findings that during ischemia transmitters are released from the cytoplasm. In addition, the major findings of this study that hypothermia of brain slice preparations prevents the extracellular calcium concentration ([Ca2+]o)-independent non-vesicular transmitter release induced by ischemic insults, inhibiting Na+/Cl--dependent membrane transport of monoamines and their toxic metabolites into the extracellular space, where they can exert toxic effects

Superficial temporal artery access for carotid artery stenting: A case report

Abstract Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66‐year‐old man who presented with critical right internal carotid artery (ICA) stenosis after previous hospitalization due to stroke. In addition to arteria lusoria, the patient had known bilateral femoral amputation, occlusion of the left ICA and significant three‐vessel coronary artery disease. After unsuccessful common carotid artery (CCA) cannulation from the right distal radial artery access, we successfully performed the diagnostic angiography and the planned right ICA‐CCA intervention using superficial temporal artery (STA) puncture. We showed that STA access can be used as an alternative and additional access site for diagnostic carotid artery angiography and intervention when standard access sites alone are insufficient

Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis

The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral artery disease. Five databases (Medline (via PubMed), EMBASE, Scopus, Web of Science, and CENTRAL) were searched systematically for studies comparing the effects of the two types of anticoagulants in patients with PAD, with an emphasis on lower-limb outcomes, cardiovascular events, and mortality. In PAD patients with concomitant non-valvular atrial fibrillation (NVAF), the use of DOACs significantly reduced the risk of major adverse limb events (HR = 0.58, 95% CI, 0.39–0.86, p p p p = 0.2) and cardiovascular mortality (HR = 0.77, 95% CI, 0.58–1.02, p = 0.07). Rivaroxaban at higher doses significantly increased the risk of major bleeding (HR = 1.16, 95% CI, 1.07–1.25, p p = 0.14) in PAD patients in whom a poor distal runoff was the reason for the anticoagulation. DOACs have lower rates of major limb events, stroke, and mortality than VKAs in PAD patients with atrial fibrillation. Rivaroxaban at higher doses increased the risk of major bleeding compared with other DOAC drugs. More high-quality studies are needed to determine the most appropriate anticoagulation regimen for patients with lower-limb atherosclerosis

Finding the optimal access for proximal upper limb artery (PULA) interventions: Lessons learned from the PULA multicenter registry

Objective The multicenter proximal upper limb artery (PULA) Registry was created to study the optimal puncture sites for the interventions involving the subclavian, axillary, and innominate arteries. Background Little is known about the optimal vascular access for PULA interventions, despite the well-known technical complexity of these procedures. Methods We performed the retrospective analysis of consecutive patients treated for symptomatic steno-occlusive disease of the proximal upper limb arteries between January 2015 and December 2019 in three high-volume centers. Acute thrombotic occlusions were excluded from the study. Results Two hundred and seventy-two patients were treated for significant stenosis and 108 for total occlusion. The baseline patient's characteristics were similar, except for the higher median age of the stenotic patients: 68.5 years (31.1; 90.0) versus 64 years (38.0; 86.0) p = 0.0015. Successful revascularization rate was higher in the stenotic group 93.75% (255/272) versus 86.11% (93/108) p = 0.0230, while the procedure length 27 min (8; 133) versus 46 min (7; 140) p = 0.0001 and fluoroscopy times 439 s (92; 2993) versus 864 s (86; 4176) p = 0.0001 were higher in the occlusion group. The main adverse event rate was similarly low. Dual access was used more often to treat occlusions (60.19% (65/108) vs. 11.40% (31/272) p = 0.0001) without significantly increasing the complication rate. The safest access was ultrasound-guided distal radial artery puncture, significantly better than conventional radial access with 0% (0/31) versus 13.6% (18/131) p = 0.0253 complication. Conclusions The percutaneous revascularization of proximal upper limb arteries is a safe and effective. Dual access can be applied to increase treatment efficacy, without significantly compromising safety

Mesterséges intelligencia alapú országos döntéstámogató rendszer bevezetése a hazai stroke-ellátás javítására = Introduction of Artificial Intelligence Based National Decision Support System to Improve Stroke Care in Hungary

BEVEZETÉS – Ischaemiás stroke esetén a re kanalizációs kezelés indikációja képalkotó vizsgálatokon alapul. Az indikáció felállításával, szükség esetén a képanyag más intézménybe történô továbbításával járó idôveszteség minimalizálása érdekében mes ter séges intelligenciával (MI) mûködô stroke képalkotó hálózatot (eStroke-hálózat) alakítottunk ki Magyarországon. A jelen közlemény célja ennek a bemutatása. ANYAG ÉS MÓDSZER – Az Országos Men tális Ideggyógyászati és Idegsebészeti In té zet (OMIII) szervezésében kiépített hálózatba 28 stroke-központot, köztük négy thrombectomiás központot vontunk be. A Pécsi Egyetem által korábban kiépített, és az OMIII projekttel párhuzamosan bôvített hálózat 10 centrumot fed le, így az ország 38 stroke-központjában érhetô el a szolgáltatás. A stroke-CT-vizsgálatok mindegyik köz pontból automatikusan egy központi te leradiológiai szerveren át a központi kép elemzô szerverre kerülnek, ahol MI-alapú szoftver (eStroke, Brainomix Ltd.) vizsgálja az ischaemiás terület kiterjedését (ASPECTskála), a nagyérelzáródás tényét és lokalizációját, a kollaterális keringés minôségét, va lamint a standard CT-perfúziós paramétereket. A feldolgozott képek és az eredmények automatikusan visszakerülnek a küldô intézet és a releváns thrombectomiás központ képarchiváló rendszerébe, valamint elérhetôvé válnak anonimizált formában, felhôszolgáltatáson keresztül asztali számítógépen vagy mobilapplikációban. EREDMÉNYEK – Mûködésének elsô egy éve alatt a rendszer 16276 betegrôl készült 38060 szkent dolgozott fel. Az OMIII ta pasztalatában, 65, illetve 152 betegbôl álló mintában másodlagos betegtranszport esetén a Mentôszolgálathoz érkezô elsô se gélyhívástól a thrombectomiás központba érkezésig eltelô idô ezen idôszakban 38 perccel, 4 óra 18 percrôl 3 óra 40 percre csökkent. KÖVETKEZTETÉS – Az akut stroke-ellátás eredményeinek javítása technikailag lehetséges a központi MI-alapú képalkotó hálózat kialakításával. Az eStroke-hálózat mû ködtetése rövidíti a betegszállítási transzportidôket, de ennek további optimalizálása szükséges. | INTRODUCTION – Indication for recanalization therapy of acute ischemic stroke is based on imaging procedures. In order to minimize the time loss passing by recog nizing the condition and the transfer of images to other facility, we established a stroke imaging network (eStroke network) supported by Artificial Intelligence (AI) in Hungary. Our study aims to present this system. METHODS AND MATERIAL – Organized by the National Institute of Mental Health, Neurology, and Neurosurgery (NIMNN), we included a total of 28 stroke centers, among them 4 thrombectomy centers. An earlier network of the University of Pécs and the widened network parallel with the NIMNN project cover 10 centers thus the service is now available in 38 stroke centers of this country. Stroke CT scans are automatically transmitted via the central teleradiology server to a central image processing server which analyzes the size of the ischemic area (ASPECT score), detects large vessel occlusion and it’s localization, analyzes the quality of collateral circula tion and standard CT perfusion parameters using an AI based software (eStroke, Brainomix Ltd.). Results and processed images are sent automatically back to the PACS system of the sending institution and that of the concerning thrombectomy center and become available in anonymous form via cloud by desktop computers or mobile application. RESULTS – During the first year of opera tion, the system has processed 38,060 scans of 16,276 patients. In NIMNN experience by samples of 65 and 152 cases, for drip and ship patients the time from the first alerting of the ambulance service, until arrival at the thrombectomy center was reduced by 38 minutes from 4:18 to 3:40 minutes. CONCLUSION – Building an AI based central stroke imaging network for improving of stroke care’s results is technically feasible. Operation of the eStroke system is capable of reducing patient transportation times, however, further optimization is needed

Gasztroenterológiai-kardiológiai multidiszciplináris konszenzus a hatékony gasztroprotekció szükségességéről antitrombotikus kezelés alkalmazásakor : A Magyar Gasztroenterológiai Társaság és a Magyar Kardiológusok Társaságának közös állásfoglalása

Az antitrombotikus (thrombocytaaggregáció-gátló – TAG és antikoaguláns) szerek alkalmazása nélkülözhetetlen a szív- és érrendszeri (kardiovaszkuláris – CV) betegségek kezelésében. Az antitrombotikus szerek alkalmazása azonban növeli a tápcsatornai vérzések kockázatát. A megelőzés során a CV és a gasztrointesztinális (GI) kockázati tényezőket egyaránt figyelembe kell venni és hatékony gyomornyálkahártya-védelmet (gasztroprotekciót) kell alkalmazni. A gasztroprotekció alapja a hatékony savszekréció-gátlás. A protonpumpagátló (PPI)-szerek biztosítják a leghatékonyabb gasztroprotekciót. Az antitrombotikus kezelés során az esetek egy részében nem történik hatékony gasztroprotekció, amely a PPI elégtelen alkalmazásával magyarázható. A hatékony gasztroprotekciót illetően jelenleg nem áll rendelkezésre naprakész magyar útmutató vagy ajánlás. A közlemény a legújabb evidenciák tükrében, elismert hazai kardiológus és gasztroenterológus szakértők multidiszciplináris konszenzusa alapján összefoglalja az antitrombotikus kezelés során alkalmazandó gasztroprotekció legfontosabb gyakorlati szempontjait. | Antithrombotic (antiplatelet and anticoagulant) therapy is essential in the treatment of cardiovascular (CV) di- sorders. However, their use is associated with increased risk of gastrointestinal bleeding. During the effective prevention, both CV and gastrointestinal (GI) risks should be taken into account and effective gastroprotection should be used. The basis of gastric mucosal defence (gastroprotection) is effective gastric acid inhibition. Proton pump inhibitor (PPI) therapy provides the most effective gastroprotection. During antithrombotic therapy there is an insufficient use of effective gastroprotection, which can be explained by an underuse of PPIs. There are no up-to-date Hungarian recommendations regarding the effective gastroprotection. This paper aims to develop sta- tements and guidance devoted to these specific issues through a review of current evidence by a multidisciplinary group of known experts from the field of cardiology and gastroenterology

sj-docx-1-tan-10.1177_17562864221139632 – Supplemental material for Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis

Supplemental material, sj-docx-1-tan-10.1177_17562864221139632 for Endovascular treatment for anterior circulation large-vessel occlusion ischemic stroke with low ASPECTS: a systematic review and meta-analysis by Apostolos Safouris, Lina Palaiodimou, István Szikora, Odysseas Kargiotis, George Magoufis, Klearchos Psychogios, Georgios Paraskevas, Stavros Spiliopoulos, Elias Brountzos, Sándor Nardai, Nitin Goyal, Diana Aguiar De Sousa, Daniel Strbian, Valeria Caso, Andrei Alexandrov and Georgios Tsivgoulis in Therapeutic Advances in Neurological Disorders</p